No one seem to care the quality of the data . Every one bothers about the quality of the Author and Journal instead . if its X Y Z its ok If its A B C no its not acceptable data.

Probably , Data is most misused word in medical science.

In scientific world, “unpublished sense” goes straightway to dustbin ,while we have so many avenues for the published nonsense to be celebrated (Still, bulk of guidelines in cardiology is backed up by Level C evidence which means experience of experts !)

By the way what do we mean by data ?

Its organised collection of genuine scientific information , that’s post processed , follow it up with sound inference and faithful questioning and debate that should ultimately end up as “clinical application” in patient domain for consumption.(No prizes for guessing , whats happening in real world !)

OMG, give us back that elusive Common sense . . . which I think we lost some time at the turn of this millennium !

Wrong or useless data : Who will recall ?

Once applied to patient , these data is to be scrutinized and monitored . If we find a study conclusion and reality does not match , we need to stall the data from adversely exploding .Every stake holder should have the power to do it. There have been instances a treatment modality got banished in one country is legally permitted in other country knowing fully well the futility.

Final message

Modern scientific Data* is not God sent. Its created , synthesised and disseminated in various mind factories. All you require is , backing up with some pioneering journal publication with huge impact factor.It’s not really blasphemy to question things which doesn’t make sense .Unfortunately , wrong data can be tackled only with further data .(There is no other means I guess !)

When does “good common sense” become harddata and evidence ?

Its the act of publication , so please guys whenever you find some contamination in so-called scientific data please post here. To begin with I am registering a new Journal “Commonsense journal in cardiology”

*Please note, data is not a bad word as this write-up seem to suggest.Naturally occurring , epidemiological and observational data about diseases are the foundations for medical science .The issue become murky when few motivated humans play brutal games at the sensitive interface between science and truth.

It should be acknowledged , there is a distinct risk of this fight against falsehood end up in blocking true progress of science . Still , Homo sapiens are (believed to be !) intelligent enough to differentiate good from bad , that’s the reason God gave us the sixth sense !

We all know to err is human , but most of us probably won’t agree medical mistakes , (bulk of which happen in the name of practicing state of the art of science ! ) could be the dominant theme in modern medical care !

BMJ exposes this well known secret with the help of most authentic data from an apex scientific body CDC , Atlanta .

Inability to think beyond self , family, private life reflects a backward and immature state of human mind

How to eradicate this backwardness we all suffer from !

I stumbled upon a book which made me wonder , whether eradication of backwardness is little to do with education ! It lies much, much deeper in our cortical thinking influenced by inheritance , evolution , culture and economy .

The stunning truth was exemplified by American political scientist Edward C. Banfield .A must read for every one who have mind for society , community and the humanity !

In this book he introduced a new term to describe this self centered thinking as “Amoral familism”

“Banfield concluded that human plight was rooted in the distrust, envy and suspicion displayed by them in relations with each other. Fellow citizens would refuse to help one another, except where one’s own personal material gain was at stake. Many attempted to hinder their neighbors from attaining success, believing that others’ good fortune would inevitably harm their own interests”

Banfield theroy and “Moral Bankruptcy in Modern medical care”

I am afraid there is a compelling link between Banfield’s observation in a remote Italian village to the current medical community mind set who care only for their patients who pay them and keep them happy !

If you think education will eradicate social backwardness ,Why ? one of the most highly educated community that form the noble profession remain backward in their thinking !

How do you explain innumerable instances of hospitals , doctors shutting doors for lesser humans even in dire emergencies ! ?

Why do many of them join hands with powers that can be detrimental to the overall health of the society ?

The stunning irony is , they do it unashamed (with pleasure at times!) in violation of the oath they take when they join the Noble profession. Shall we call it as ” Moral Bankruptcy in medical care ?

Read further

Moral Basis of a Backward Society

Highlights of this book (Text from Wikipedia)

The Moral Basis of a Backward Society is a book by Edward C. Banfield, a political scientist who visited Montegrano, Italy . He observed a self-interested, family centric society which sacrificed the public good for the sake of nepotism and the immediate family. Banfield as an American was witnessing what was to become infamous as the “mafia” or families that cared only for its own “members” at the expense of their fellow citizens. Banfield postulated that the backwardness of such a society could be explained ‘largely but not entirely’ by ‘the inability of the villagers to act together for their common good or, indeed, for any end transcending the immediate, material interest of the nuclear family’.

Note :This is a copy of my earlier blog on coronary micro-circulation published few years ago.Recently this got numerous hits .Hence I have just reposted it with slight modification.

Human coronary circulation stands unique among others as it is a life-sustaining circulation.It is indeed a great medical achievement to visualise the right and left coronary artery system by coronary angiogram. Actually, what we see is only a fraction of the surface area of coronary circulation .The surface area of epicardial coronary arteries constitutes less than 5 % of entire coronary vascular tree .

This is the reason normal coronary angiogram can never mean normal coronary circulation !

This huge gap in our perception is the single important factor that explains the vagaries of modern coronary care .

This also make any clinical coronary scenario a reality .

“A patient with normal coronary angiogram getting a myocardial infarction , the next day and a severe triple vessel disease living comfortably for decades with medical management”

So , it is essentially a false sense of scientific accomplishment by the cardiac scientists at least in the of coronary circulatory physiology.

What determines the extent of these invisible coronary micro circulation ?

There are innumerable channels of micro vessels traversing across the heart, sharing , bridging , branching, penetrating and perfusing the muscle mass.They can be anatomically patent , physiologically non patent .They can be recruited by hemodynamic stress .These are never visualized by current imaging modalities..It is also influenzed by favorable growth milieu and hormonal and neural stimuli.

Ignorance based cardiology

What is the mechanism of primary VF following acute STEMI ?

The quantum of coronary micro circulation is like the vast cerebral neuronal net work .We have every reasons to believe they are have unique genetic imprint.How else you can explain a man with full blown STEMI come 24 hours later comfortably to the OPD while another loses his life with a stormy primary VF before even boarding the ambulance !

Why many cardiologists do not give due credit the coronary collateral circulation ?

It has been our traditional teaching ( without much evidence of course !) coronary collateral circulation is not effective to support blood flow during exercise . This fact has been disproved many times . Coronary collateral circulation was indeed useful in limiting damage in ACS and relieve symptoms in stable angina.It helps in reverse remodeling and provided electrical stabilty as well in post MI population.

Still , the concept was alienated and made totally irrelevant in the interventional era . Many cardiologists found well-developed collateral’s as an interference to their expertise and ego since it has a potential to alter the indication of PCI.They continue to have strong scientific conviction (Pseudo ?) that man made collaterals must always been superior to God made collaterals !

Whenever some credible reports emerge about collateral circulation being equivalent to revascularisation procedure , these concepts were prematurely buried for some reason.

In the last decade there was a concern about performing PCI in patients with well-developed collaterals .The argument was , they tend to develop early stent occlusion and restenosis . It was a genuine query raised by few thought leaders in the field as collateralised vessels suffer from low flow after PCI , if the pre -existing collateral continue to function.

But then , few studies countered this , and PCI was shown to be safe and in fact may fare well in patients with extensive collaterals .

In these studies interventionist’s argument looked amusing ! as they seem to define a successful PCI as not only to open the occluded vessel but also make sure to close all functioning collaterals .(What a a pity for our natural biological angiogenic forces which had worked and grown meticulously for months!)

Cardiac science in the current format, makes the future look bleak for coronary a collateral circulation .With early PCI becoming a norm we will never ever allow the natural collaterals to grow , and even the established collaterals will have to face a stiff fight for survival with sophisticated coronary interventions .

Competing interest in the filed of coronary collateral research

While the basic scientists want to grow collaterals with angiogenesis , stem cells etc interventionists continue to indulge in rampant angioplasties which will suppress collateral growth.

This implies we will struggle to establish the true importance of coronary collateral circulation .

Final message

Can it be an effective form of revascularisation ?

My personal inference is coronary collateral circulation “would and should” have a definite role in at- least some of the subsets with chronic coronary syndromes. If we think otherwise . . . it’s against the principle of natural biological science .

A good collateral system with optimal medical management can save not only our patient’s lives but also their hard earned currencies !

Reference

Here is a rare article in European heart journal that discuses coronary collateral circulation . Let us welcome such wonderful reviews which keep the interest alive on the filed.

It all started in 2008. This is 6th year of my attempt to share knowledge in cardiology.The followers of my blog is the only strength that sustain my writing .

Wishing you all a Happy , wonderful and a prosperous , New year 2014

But . . . please be reminded we don’t require a New year to bring a bout of happiness , it is sitting right in our minds every day !

On this day let me quote my most revered quote of Hemmingway.

Ernest Hemmingway the Nobel laureate who was born in USA, Lived in Paris , fought in world war 2 , lived in the deep forests of Africa with wild animals during the fag end of his life .He had a Intimate relationship with Cuba, made a passionate appeal to end the man made disaster called wars in this planet , before his life ended in 1961.